Healthcare Provider Details

I. General information

NPI: 1043299050
Provider Name (Legal Business Name): CLAUDE L LAVALLEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SAVANNAH RD
LEWES DE
19958
US

IV. Provider business mailing address

PO BOX 3012
WILMINGTON DE
19804
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3296
  • Fax: 302-645-3862
Mailing address:
  • Phone: 302-224-5678
  • Fax: 302-224-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC10003924
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: